This patient is a 75 year old woman who suffered from recurrent chest pain. Multiple stress perfusion SPECT scans had been normal. Finally, she underwent coronary angiography which showed significant stenoses of the distal left main artery, the proximal circumflex artery, and the distal right coronary artery. The "balanced" stenoses probably accounted for the false negative perfusion scans. She then underwent heart surgery with a LIMA graft to her LAD and saphenous vein grafts to her 2nd obtuse marginal and posterior descending arteries. Two years later, she experienced recurrent chest pain. Because of the many previous false negative perfusion stress tests, she underwent a CT coronary angiogram.
The central image shows the anterior surface of the heart with the LIMA graft to the LAD and saphenous vein graft to the 2nd obtuse marginal artery. The left images show the course of the widely patent LIMA graft, its anastamosis to the mid LAD, and good retrograde filling of the LAD. The right images show the origin and course of the saphenous vein graft and its anatamosis to the 2nd marginal artery.
The central image shows the inferior surface of the heart with a saphenous vein graft to the posterior descending artery. The left images show the proximal and distal anatomoses of the vein graft. The right image shows the graft to be widely patent throughout its course.
This study clearly demonstrates that the patient remains well vascularized with all of her grafts widely patent. She was reassured, her customary medical therapy was continued, and her chest pain resolved without clinical incident.
Coronary CT angiography is unusually well suited to studying graft anatomy because grafts are generally larger and less mobile than the native coronary arteries.